Condition Management and Documentation Consultant

Job Summary

Coordinates, facilitates, implements, and participates as a subject matter expert within the organization for Condition Management & Documentation (CMD). The role is responsible for education, performance improvement planning and monitoring the comprehensive Condition Management & Documentation plan for AAH. This is an enterprise role with primary focus on contracts held by APP and employed Medical Groups. The role partners closely with the Coding and Auditing teams. This role implements new and existing healthcare CMD strategies, provides education and workflow recommendations to providers, identifies EHR CMD related opportunities, troubleshoots and tests CMD related EHR enhancements and conducts data collection; and is responsible for monitoring key performance measurement activities.

Major Responsibilities:

• Develops, coordinates, and implements the strategic direction of the CMD program as it relates to the education for Advocate Aurora Health and Advocate Physician Partners. This includes providing education, consultation and direction to the providers and all levels of the organization as it relates to managing clinical risk.
• Develops, standardizes, maintains, and implements risk adjustment training programs, materials, websites and workflows for all areas of the organization to achieve CMD program goals.
• Serves as the subject matter expert and internal primary point of contact for all Condition Management & Documentation related topics and guidance by maintaining an expert level of knowledge of Medicare and risk-based reimbursement methodology including CMS & IMO updates affecting HCCs, ICD 10 coding practices, Medicare/HHS risk adjustment models, Hierarchical Condition Categories (HCCs) and Risk Adjustment Factors (RAFs), clinical/charge capture functionality, internal processes and maintains professional and technical knowledge through webinars, workshops, professional publications and personal networking.
• Works with coding/coding auditors to develop work ques/rules to identify CMD related focus areas for querying and missed codes and coordinate manual chart reviews of a practice to analyze clinical documentation to identify patterns and trends to develop appropriate Performance Improvement plans.
• Participates with coding and compliance in risk-adjustment chart reviews including RAD-V/RACCR audits to identify patterns and trends and shares findings as appropriate.
• Participates in EHR updates related to CMD IMO/best practice alerts (BPA’s)/suspect condition and grouper updates from CMS and has knowledge of clinic workflows and Epic workflows to be able to troubleshoot for informatics, test new EHR CMD related programming and put forth possible solutions.
• Develops and maintains effective internal relationships through effective and timely communication.
• Data mines & synthesizes raw data and organizes key performance indicators, presents information, and provides summary of material. Provides analysis and reporting on progress and results including the overall re-evaluation rate, improvement strategies and tactics.
• Collaborates with quality, operations and providers to develop recommendations to complete PDSA/Improvement plans to drive CMD improvement that includes creating tools and reports to meet CMD goals.
•  Collaborates with other stakeholders such as: IT, Population Health, Quality Improvement, Advocate Physician Partners Compliance, IP CDI, Coding and Informatics, other members of the CRA Team, Primary Care and Specialty Service Lines to develop new EHR tools, optimize existing functionality, identify clinical documentation and coding opportunities and develop system processes that work with the designated EHR.

Licensure, Registration, and/or Certification Required:

Health Information Administrator (RHIA) registration issued by the American Health Information Management Association (AHIMA), or Registered Nurse license issued by the state in which the team member practices, or

Certified Risk Adjustment Coder (CRC) issued by American Academy of Professional Coders (AAPC). needs to be obtained within 1 year.

Education Required:

Bachelor's Degree in Health Information Management, or Bachelor's Degree in Nursing or related field.

Experience Required: Typically requires 5 years of experience in healthcare (payer, population health, quality, coding, managing health care clinical risk or similar industry)